Step 1: General User Information Entry

Once your data is submitted it will
be processed by a KANPHIX User Manager. Once your information has been processed
by the KPM, you will be issued a SecuRID token (if applicable), user name, and instructions on how
to access the KANPHIX web portal.

* Denotes a required field

Job Title:

*

Legal First Name:

*

Legal Middle Initial:

*

Legal Last Name:

*

Suffix Name:

Work Phone Number:

*

Work Phone Extension:

Work E-Mail Address:

*

Security Question:

*

Security Answer:

*

Type the characters you see in the picture

To hear the code, click the speaker Icon to the left of these instructions.
If you cannot read the code, click the refresh button to the left of these
instructions to have a new code generated for you.